Colon & Rectal Surgery

Skin Cancers

Skin cancer is the most commonly diagnosed cancer in the United States. However, the actual number of the most common types – basal cell and squamous cell skin cancer (i.e., keratinocyte carcinoma), more commonly referred to as nonÂ­melanoma skin cancer (NMSC) – is very difficult to estimate because these cases are not required to be reported to cancer registries. The most recent study of NMSC occurrence estimated that in 2006, 3.5 million cases were diagnosed among 2.2 million people. NMSC is usually highly curable.

An estimated 73,870 new cases of melanoma will be diagnosed in 2015. Melanoma accounts for less than 2% of all skin cancer cases, but the vast majority of skin cancer deaths. It is most comÂ­monly diagnosed in non-Hispanic whites; the annual incidence rate is 1 (per 100,000) in blacks, 4 in Hispanics, and 25 in non- Hispanic whites. Incidence rates are higher in women than in men before age 50, but by age 65, they are twice as high in men as in women, and by age 80 they are triple. The differences in risk by age and sex primarily reflect differences in occupational and recreational sun exposure, which have changed over time. OverÂ­all, melanoma incidence rates rose rapidly over the past 30 years. However, trends vary by age and appear to be plateauing in younger age groups. From 2007 to 2011, incidence rates were stable in men and women younger than age 50, but increased by 2.6% per year in those 50 or older.

Signs and symptoms: Important warning signs of melanoma include changes in the size, shape, or color of a mole or other skin lesion, the appearance of a new growth on the skin, or a sore that doesn’t heal. Changes that progress over a month or more should be evaluated by a doctor. Basal cell carcinoma may appear as a growth that is flat, or as a small, raised pink or red translucent, shiny area that may bleed following minor injury. Squamous cell carcinoma may appear as a growing lump, often with a rough surface, or as a flat, reddish patch that grows slowly.

Risk factors: Risk factors vary for different types of skin cancer. For melanoma, major risk factors include a personal or family history of melanoma and the presence of atypical, large, or numerous (more than 50) moles. Risk factors for all types of skin cancer include sun sensitivity (e.g., sunburning easily, difficulty tanning, or natural blond or red hair color); a history of excessive sun exposure, including sunburns; use of tanning beds; diseases or treatments that suppress the immune system; and a past hisÂ­tory of skin cancer.

Treatment: Most early skin cancers are diagnosed and treated by removal and microscopic examination of the cells. Early stage basal cell and squamous cell cancers can be treated in most cases by one of several methods: surgical excision, electrodesicÂ­cation and curettage (tissue destruction by electric current and removal by scraping with a curette), or cryosurgery (tissue destruction by freezing). Radiation therapy and certain topical medications may be used in some cases. For malignant melaÂ­noma, the primary growth and surrounding normal tissue are removed and sometimes a sentinel lymph node is biopsied to determine stage. More extensive lymph node surgery may be needed if the sentinel lymph nodes contain cancer. Melanomas with deep invasion or that have spread to lymph nodes may be treated with surgery, immunotherapy, chemotherapy, and/or radiation therapy. Advanced cases of melanoma are treated with palliative surgery, newer targeted or immunotherapy drugs, and sometimes chemotherapy and/or radiation therapy. The treatÂ­ment of advanced melanoma has changed in recent years with the FDA approval of targeted drugs such as vemurafenib (ZelboÂ­raf®), dabrafenib (Tafinlar®), and trametinib (MekinistTM) and the immunotherapy drug ipilimumab (Yervoy®).

Survival: Almost all cases of basal cell and squamous cell skin cancer can be cured, especially if the cancer is detected and treated early. Although melanoma is also highly curable when detected in its earliest stages, it is more likely than NMSCs to spread to other parts of the body. The 5- and 10-year relative surÂ­vival rates for people with melanoma are 91% and 89%, respectively. For localized melanoma (84% of cases), the 5-year survival rate is 98%; survival declines to 63% and 16% for regional and distant stage disease, respectively.